Divine Residential Care Agency, LLC
Organization Active NPI Assisted Living Facility · Winona, MS
NPI 1457775744 · NPPES record last updated Feb 7, 2014
Key facts
- NPI
- 1457775744
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- Legal business name
- DIVINE RESIDENTIAL CARE AGENCY, LLC
- Practice address
- 506 Speedway Ave
Winona, MS 38967-1816 - Phone
- (901) 281-2747
- Fax
- (662) 470-5771
- NPI assigned
- Feb 7, 2014
- Organization subpart
- No
Authorized official
- Name
- Daphaine Moore Blakes
- Title
- Ceo
- Phone
- (901) 281-2747
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Yes |
Addresses
Primary practice location
506 Speedway Ave
Winona, MS 38967-1816
Mailing address
7061 Foxhall Dr
Horn Lake, MS 38637-1269
Phone (901) 281-2747
Other providers in Winona, MS
- Dabbs Brothers LLC
- Daniel M Dabbs
- Deborah M Davis
- Hannah Davis
- Devine Interventions Inc.
- Easy Feet LLC
- Fairview Home Health Services
- Family Health Care Clinic, Inc.
- Taylor Forrest
- Amy Marie Gammel
All providers in Winona, MS · Assisted Living Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.